Dean K Matsuda1, Andrew B Wolff2, Shane J Nho3, John P Salvo4, John J Christoforetti5, Benjamin R Kivlan6, Thomas J Ellis7, Dominic S Carreira8. 1. DISC Sports and Spine Center, Marina del Rey, California, U.S.A.. Electronic address: saltandlight777@hotmail.com. 2. Hip Preservation and Sports Medicine, Washington Orthopaedics and Sports Medicine, Washington, DC, U.S.A. 3. Department of Orthopedic Surgery, Division of Sports Medicine, Hip Preservation Center, Rush University Medical Center, Chicago, Illinois, U.S.A. 4. Rothman Institute, Philadelphia, Pennsylvania, U.S.A.; Orthopedic Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, U.S.A. 5. Center for Athletic Hip Injury, Allegheny Health Network, Pittsburgh, Pennsylvania, U.S.A.; Department of Orthopaedic Surgery, Drexel University School of Medicine, Pittsburgh, Pennsylvania, U.S.A.; American Hip Institute, Pittsburgh, Pennsylvania, U.S.A. 6. Department of Physical Therapy, Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania, U.S.A. 7. Orthopedic One, Columbus, Ohio, U.S.A.; Ohio Orthopedic Surgery Institute, Columbus, Ohio, U.S.A.; Dublin Methodist Hospital, Columbus, Ohio, U.S.A. 8. Peach Tree Orthopaedics, Atlanta, Georgia, U.S.A.
Abstract
PURPOSE: To report observational findings of patients with acetabular dysplasia undergoing hip arthroscopy. METHODS: We performed a comparative case series of multicenter registry patients from January 2014 to April 2016 meeting the inclusion criteria of isolated hip arthroscopy, a documented lateral center-edge angle (LCEA), and completion of preoperative patient-reported outcome measures. A retrospective analysis compared range of motion, intra-articular pathology, and procedures of patients with dysplasia (LCEA ≤25°) and patients without dysplasia (LCEA >25°). RESULTS: Of 1,053 patients meeting the inclusion criteria, 133 (13%) had dysplasia with a mean LCEA of 22.8° (standard deviation, 2.4°) versus 34.6° (standard deviation, 6.3°) for non-dysplasia patients. There were no statistically significant differences in preoperative modified Harris Hip Score, International Hip Outcome Tool-12 score, or visual analog scale score (pain). Cam deformity occurred in 80% of dysplasia patients. There was a significant difference in internal rotation between the dysplasia (21°) and non-dysplasia groups (16°, P < .001). Mean internal rotation (33.5°; standard deviation, 15.6°) of the dysplastic subjects without cam morphology was greater than that of the dysplastic patients with cam morphology (18.5°; standard deviation, 11.6°; P < .001). Hypertrophic labra were found more commonly in dysplastic (33%) than non-dysplastic hips (11%, P < .001). Labral tears in patients with dysplasia were treated by repair (76%), reconstruction (13%), and selective debridement (11%); labral treatments were not significantly different between cohorts. The most common nonlabral procedures included femoroplasty (76%) and synovectomy (73%). There was no significant difference between the dysplasia and non-dysplasia groups regarding capsulotomy types and capsular closure rates (96% and 92%, respectively). CONCLUSIONS: Dysplasia, typically of borderline to mild severity, comprises a significant incidence of surgical cases (13%) by surgeons performing high-volume hip arthroscopy. Despite having similar preoperative pain and functional profiles to patients without dysplasia, dysplasia patients may have increased flexed-hip internal rotation. Commonly associated cam morphology significantly decreases internal rotation. Arthroscopic labral repair, femoroplasty, and closure of interportal capsulotomy are the most commonly performed procedures. LEVEL OF EVIDENCE: Level III, therapeutic comparative case series.
PURPOSE: To report observational findings of patients with acetabular dysplasia undergoing hip arthroscopy. METHODS: We performed a comparative case series of multicenter registry patients from January 2014 to April 2016 meeting the inclusion criteria of isolated hip arthroscopy, a documented lateral center-edge angle (LCEA), and completion of preoperative patient-reported outcome measures. A retrospective analysis compared range of motion, intra-articular pathology, and procedures of patients with dysplasia (LCEA ≤25°) and patients without dysplasia (LCEA >25°). RESULTS: Of 1,053 patients meeting the inclusion criteria, 133 (13%) had dysplasia with a mean LCEA of 22.8° (standard deviation, 2.4°) versus 34.6° (standard deviation, 6.3°) for non-dysplasiapatients. There were no statistically significant differences in preoperative modified Harris Hip Score, International Hip Outcome Tool-12 score, or visual analog scale score (pain). Camdeformity occurred in 80% of dysplasiapatients. There was a significant difference in internal rotation between the dysplasia (21°) and non-dysplasia groups (16°, P < .001). Mean internal rotation (33.5°; standard deviation, 15.6°) of the dysplastic subjects without cam morphology was greater than that of the dysplasticpatients with cam morphology (18.5°; standard deviation, 11.6°; P < .001). Hypertrophic labra were found more commonly in dysplastic (33%) than non-dysplastic hips (11%, P < .001). Labral tears in patients with dysplasia were treated by repair (76%), reconstruction (13%), and selective debridement (11%); labral treatments were not significantly different between cohorts. The most common nonlabral procedures included femoroplasty (76%) and synovectomy (73%). There was no significant difference between the dysplasia and non-dysplasia groups regarding capsulotomy types and capsular closure rates (96% and 92%, respectively). CONCLUSIONS:Dysplasia, typically of borderline to mild severity, comprises a significant incidence of surgical cases (13%) by surgeons performing high-volume hip arthroscopy. Despite having similar preoperative pain and functional profiles to patients without dysplasia, dysplasiapatients may have increased flexed-hip internal rotation. Commonly associated cam morphology significantly decreases internal rotation. Arthroscopic labral repair, femoroplasty, and closure of interportal capsulotomy are the most commonly performed procedures. LEVEL OF EVIDENCE: Level III, therapeutic comparative case series.
Authors: Rebecca M Woodward; Renuka M Vesey; Catherine J Bacon; Steve G White; Matthew J Brick; Donna G Blankenbaker Journal: Skeletal Radiol Date: 2020-06-25 Impact factor: 2.199
Authors: Matthew D LaPrade; Heath P Melugin; Rena F Hale; Devin P Leland; Christopher D Bernard; Rafael J Sierra; Robert T Trousdale; Bruce A Levy; Aaron J Krych Journal: Orthop J Sports Med Date: 2021-03-05